Antibiotics - Macrolides: Nursing pharmacology

Macrolides are a class of antibiotics used to treat a wide range of infections caused by gram-positive and gram-negative bacteria.

These medications include erythromycin, azithromycin, and clarithromycin. All can be administered orally to treat mild to moderate bacterial infections of the respiratory, gastrointestinal, and genitourinary tracts; erythromycin can also be given intravenously, and azithromycin has an ophthalmic formulation to treat bacterial conjunctivitis.Now, once administered, macrolides target the bacterial 50S ribosomal subunit in order to inhibit protein synthesis.

As a result, these medications have a bacteriostatic effect, meaning they stop bacterial growth. They’re also considered broad spectrum antibiotics, as they’re active against most gram-positive bacteria and moderately active against some gram-negative bacteria.Typically, macrolides are well tolerated, and rarely cause side effects.

The most common ones can include headaches, a skin rash, and gastrointestinal disturbances like diarrhea, abdominal pain, nausea, and vomiting.

In addition, macrolides may disrupt the normal intestinal flora, which can allow certain bacteria like Clostridioides difficile to survive and overgrow within the gastrointestinal tract, rarely but potentially leading to Clostridioides difficile infection or CDI for short.

Some clients on macrolides may also develop vaginitis and candidiasis, and if they’re used for a prolonged time, they can also lead to ototoxicity and hearing loss.

Now, more serious side effects include a prolonged QT interval, ventricular arrhythmias like torsade de pointes, and hepatotoxicity, potentially leading to hepatitis.

They can also cause seizures, and rare but serious hypersensitivity reactions like angioedema, Stevens-Johnson syndrome, and toxic epidermal necrolysis.

Finally, regarding specific side effects, erythromycin can cause esophagitis, while azithromycin can rarely cause thrombocytopenia; while clarithromycin can cause abnormal taste and pancreatitis.Now, macrolides are contraindicated in people with hepatic disease, and should be used with caution during pregnancy and breastfeeding, as well as in elderly clients, and in those with cardiovascular disease.

Regarding interactions, they shouldn’t be combined with medications that can prolong the QT interval, like quinidines or amiodarone; as well as with medications that inhibit CYP34A, as this can result in sudden cardiac death.

Finally, macrolides shouldn’t be used with ergot derivatives or statins, since it can affect their metabolism and increase their toxicity.Okay, when caring for a client with nongonococcal urethritis who's been prescribed an oral macrolide like azithromycin, first perform a focused assessment, including vital signs, and noting symptoms of infection, such as dysuria, burning sensation, and type of urethral discharge.

Review their most recent laboratory test results, including CBC, renal and hepatic function tests, gram stain, culture and sensitivity of the infection site, nucleic acid amplification test or NAAT, and urinalysis.

Lastly, confirm that your client does not have a known cardiac arrhythmia and is not currently prescribed any medications that are strong CYP34A inhibitors, such as calcium channel blocker or protease inhibitor.

Next, explain to your client how the medication will help to resolve their infection. Let them know their dose is for one tablet, to be taken with or without food.

Then, describe some of the side effects they could experience, and what symptoms are important to report to their provider.

Instruct them to contact their healthcare provider if they have symptoms of CDI like abdominal cramping and loose, bloody stools; symptoms of hepatotoxicity such as dark-colored urine, anorexia, right upper quadrant pain, clay-colored stools, or yellowing of their skin or eyes; symptoms of ototoxicity such as decreased hearing, tinnitus, or dizziness; as well as symptoms of QT prolongation, which could manifest as palpitations, chest pain, dizziness or shortness of breath.Lastly, stress the importance of abstaining from sexual activity throughout the course of therapy, and for 7 days after the completion of therapy.

Finally, be sure to monitor your client for side effects, and assess for the desired therapeutic effect of infection resolution and an absence of symptoms.Alright, as a quick recap… Macrolides are a class of antibiotics that treat infections caused by gram positive and gram negative bacteria, and include erythromycin, azithromycin, and clarithromycin.

These medications work by targeting the bacterial 50S ribosomal subunit in order to inhibit protein synthesis, and ultimately stop bacterial growth.

Typically, macrolides are well tolerated, but serious side effects may rarely occur, including a prolonged QT interval, ventricular arrhythmias, hepatotoxicity, ototoxicity, as well as CDI.

When caring for a client taking a macrolide, nursing considerations include performing a baseline assessment, monitoring for side effects, and evaluating for the desired therapeutic effect of infection resolution.

Client teaching is focused on safe self-administration, what side effects to expect during treatment, and learning what symptoms should be reported to the healthcare provider.

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